How To Use CPT Code 99173

CPT 99173 is a code used for screening tests of visual acuity, quantitative, bilateral. This article will cover topics such as the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99173 procedures.

1. What is CPT 99173?

CPT 99173 is a medical billing code used for screening tests of visual acuity, quantitative, bilateral. This code is specifically designed for the assessment of a patient’s eyesight in both eyes using a standardized chart, such as a Snellen’s chart. The purpose of this test is to screen and identify any potential visual problems that may require further evaluation and treatment.

2. 99173 CPT code description

The official description of CPT code 99173 is: “Screening test of visual acuity, quantitative, bilateral.”

3. Procedure

The procedure for CPT 99173 involves the following steps:

1. The provider places a standard Snellen’s visual testing chart vertically on a stand or a wall.
2. The patient is asked to stand at a distance of 20 feet from the chart.
3. The patient removes their eyeglasses, if present, and covers one eye.
4. The provider asks the patient to read the letters from the chart, which are arranged in decreasing order of size.
5. The patient repeats the process with the other eye.
6. Based on the size of the smallest letter the patient can read accurately, the provider can screen and identify whether the patient is suffering from any visual problem that requires further evaluation.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 99173 services are those who require a screening test of their visual acuity. This test is typically performed on pediatric patients as part of their regular preventive care. The American Academy of Pediatrics (AAP) recommends that all preschool children be screened for visual acuity and strabismus by age 4. However, this code can also be used for patients of any age who require a visual acuity screening.

5. When to use CPT code 99173

It is appropriate to bill the 99173 CPT code when the visual screening test provides graduated visual acuity stimuli that allow a quantitative estimate of visual acuity, as in the Snellen’s chart. This code is commonly used during early (99382, 99392) or late childhood (99383, 99393) preventive medicine services. Some payers may not pay separately for a child’s visual acuity test, but it is essential to report 99173 to document that the service has been provided. Some Medicaid payers insist that the code be reported, even though they may not cover it separately from an E/M service.

6. Documentation requirements

To support a claim for CPT 99173, the following information needs to be documented:

• The date of the service
• The patient’s age
• The reason for the visual acuity screening
• The type of chart used (e.g., Snellen’s chart)
• The distance at which the test was performed
• The results of the test for each eye, including the smallest letter size the patient could read accurately
• Any recommendations for further evaluation or treatment based on the test results

7. Billing guidelines

When billing for CPT code 99173, it is essential to follow specific guidelines and rules. Although CPT does not require a modifier on the E/M code to show this service as a separate service, you may need to append modifier 25, Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service, to the appropriate preventive medicine service code. Some insurers set up their software systems to look for modifier 25, and without the modifier, the edit may automatically reject the screening.

8. Historical information

CPT 99173 was added to the Current Procedural Terminology system on January 1, 2000. There have been no updates to the code since its addition.

9. Similar codes to CPT 99173

Five similar codes to CPT 99173 and how they differentiate from CPT 99173 are:

1. CPT 99172: This code is used for photoscreening or automated vision screening, which is a different method of assessing visual acuity.
2. CPT 99174: This code is used for instrument-based ocular screening, which involves the use of an instrument to assess ocular alignment and refraction.
3. CPT 99177: This code is used for photoscreening or automated vision screening with remote analysis and report, which involves sending the test results to a remote location for analysis and reporting.
4. CPT 92002: This code is used for a new patient’s ophthalmological service, which is a more comprehensive eye examination than a visual acuity screening.
5. CPT 92012: This code is used for an established patient’s ophthalmological service, which is also a more comprehensive eye examination than a visual acuity screening.

10. Examples

Here are 10 detailed examples of CPT code 99173 procedures:

1. A 4-year-old child undergoing a routine visual acuity screening during a preventive medicine visit.
2. A 7-year-old child with a history of strabismus being screened for visual acuity as part of their ongoing care.
3. A 10-year-old child with a family history of vision problems undergoing a visual acuity screening to monitor their eyesight.
4. A 12-year-old child with complaints of difficulty seeing the board at school undergoing a visual acuity screening to determine if further evaluation is needed.
5. A 15-year-old child with a history of wearing glasses undergoing a visual acuity screening to assess the effectiveness of their current prescription.
6. An 18-year-old patient with no prior history of vision problems undergoing a visual acuity screening as part of a comprehensive physical examination.
7. A 25-year-old patient with a history of myopia undergoing a visual acuity screening to monitor their eyesight and determine if a prescription update is needed.
8. A 35-year-old patient with a history of diabetes undergoing a visual acuity screening as part of their regular diabetic care.
9. A 50-year-old patient with a history of glaucoma undergoing a visual acuity screening to monitor their eyesight and the progression of their condition.
10. A 65-year-old patient with a history of cataracts undergoing a visual acuity screening to assess their eyesight and determine if cataract surgery is needed.